Glaucoma

asked the Secretary of State for Social Services if he has any information as to the percentage of opticians who (a) have been trained to carry out routine screening for glaucoma, (b) have the equipment to do so and (c) are known to be doing so; and if his Department will take steps to encourage routine screening.

All ophthalmic opticians are trained in certain techniques for detecting glaucoma, one of the best being ophthalmoscopy, which is part of the routine sight test under the general ophthalmic services. We are satisfied with the GOS sight test arrangements. Opticians are required by their terms of service to refer a patient to a medical practitioner if any abnormality is detected during the sight test. Comprehensive screening for glaucoma is cost-effective only for first degree relatives of known glaucoma sufferers.

asked the Secretary of State for Social Services (1) what is the incidence of (a) glaucoma and (b) blindness and partial sightedness due to glaucoma in each of the National Health Service regions;

(2) what surveys there have been on the incidence of glaucoma; and if he will give figures showing the estimated incidence of (a) all types of glaucoma and (b) insidious glaucoma for the population aged (i) over 40 years, (ii) over 50 years (iii) over 60 years and (iv) over 70 years.

There have been no surveys by the Department of the overall incidence of glaucoma, or blindness and partial sightedness, in National Health Service regions. I understand that surveys reported in the medical press suggest that the prevalence of all types of glaucoma within the total population is around 1 per cent., with the following approximate percentages for different age groups.

Age

Per cent. suffering from glaucoma (all types)

40–50

under 1

50–60

under 1

60–70

under 1

70–80

under 3

80–90

about 10

Insidious, or open-angled glaucoma, probably affects about three-quarters of those suffering from the condition.

asked the Secretary of State for Social Services (1) what is the total number of people known to be (a) blind, and (b) partially sighted because of glaucoma; in each year, approximately, how many new cases of registrable blindness and partial sightedness due to glaucoma there are; and if he will categorise them according to age;

(2) what percentage of (a) blind and (b) partially sighted people are visually handicapped because of glaucoma.

Information on causes of visual handicap is available only for newly-registered blind and partially sighted people. For elderly people this information is collected in only one year in 10. The last time this was
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done was in 1980–81. The figures given below are provisional and are based on about 85 per cent. of new registrations.

New Registrations of Blind and Partially-sighted Persons in 1980–81 where visual handicap was diagnosed as due to Glaucoma*

Age Groups

Blind Numbers

Percentage of all new registrations

Partially Sighted Numbers

Percentage of all new registrations

0–1

1

1.4

1

2.7

2–15

—

—

—

—

16–39

5

1.4

4

1.4

40–54

18

4.7

13

4.0

55–64

67

9.8

81

12.2

65–74

264

15.0

239

15.5

75–84

666

18.1

441

15.5

85+

279

13.3

154

12.9

Age Unknown

2

22.2

—

—

Total

1,302

14.2

934

13.1

* includes cases where blindness or partial-sightedness is due to more than one cause, but where glaucoma is one of those causes. (In the cases of children under one year, glaucoma would be secondary to some other cause.)

asked the Secretary of State for Social Services how many operations for glaucoma are carried out annually; and what is the estimated percentage of those that could have been avoided had the glaucoma been diagnosed earlier.

The number of patients discharged in 1980 from National Health Service hospitals in England and Wales after treatment for glaucoma is estimated at 11,890, of whom 7,970 had had operations. The number of discharges in 1981 is estimated at 12,890 but figures for operations are not yet available. The effect of early detection of glaucoma on the eventual decision by the ophthalmologist to operate is not known but we have no evidence to suggest it is substantial.

asked the Secretary of State for Social Services approximately how many cases of glaucoma are annually detected early enough for treatment to prevent the glaucoma leading to visual handicap; and if he will categorise the cases according to the source of referral.

asked the Secretary of State for Social Services (1) what is the estimated percentage of those visually handicapped by glaucoma who could have avoided loss of sight if their glaucoma had been diagnosed in its early stages;

(2) if he will make it his policy to provide a routine glaucoma screening system on request for people who are aged (a) over 40 years and (b) over 50 years;

(3) if, in order to prevent unnecessary blindness caused through failure to diagnose glaucoma in its early stages, he will increase the resources available for early treatment and preliminary screening for this condition;

(4) if he will hold discussions with representatives of the Faculty of Ophthalmology about organisational changes which might lead to more people with glaucoma having the disease detected in the early stages.

We are advised that if glaucoma can be detected sufficiently early, then in most cases, visual handicap can be avoided. However the present view of the Faculty of Ophthalmologists is that glaucoma screening is cost-effective only if restricted to patients at special risk, in particular the close relatives of known glaucoma sufferers. It should be carried out only where resources are available for this work as in hospital eye departments. The Department has regular contacts with the faculty and it would be natural for us to discuss with it any specific proposals which were put forward in this field.

asked the Secretary of State for Social Services if he will estimate the cost to the (a) National Health Service and (b) social services departments of treating or helping people who are blind or partially sighted.

Information collected by the Department does not distinguish the costs of treating or helping those who are blind or partially sighted from other costs. For this reason no reliable estimate of such costs can be made.